A Visit From the Jaycos
So will JCAHO help us get to the healthcare system of the future? I think it certainly has a role and its new Shared Visions, New Pathways seems to be a positive shift in accreditation philosophy.
The cost of accreditation has always been an issue, especially when it is compared with the value of the survey process, or stated differently, the value created for the patient by an organization being accredited. JCAHO has taken a swing at both of these issues with its new philosophy.
On the cost side, the process of preparing for a survey in man-hours (and copying!) was always considered much higher than the actual charge for the Joint to come out and do the survey (a number of thousands of dollars based on the size of the organization). By making its surveys unannounced and emphasizing the importance of continual readiness, healthcare organizations are forced to build compliance with the standards into their systems. Building a system right is much less costly and more effective than trying to fix it in a hurry.
On the value side, I have heard the criticism that, at worst, JCAHO's focus on policy and procedure distracts form patient care and, at best, that JCAHO sets the bare minimum standard for "quality" care. The tracer methodology has certainly taken the focus from policies to patient care (though we still had to provide a number of binders!). When the surveyor starts thumbing through a chart, you become keenly aware that every chart, and thus every patient, needs to have all the bases covered - informed consent, pain assessment, plan of care, etc. While many of the standards focus on the very mundane topic of documentation, it does provide value to the patient for all the documentation bases to be covered. Further, JCAHO has made patient safety a key aspect of the accreditation process with its National Patient Safety Goals. You can't argue that the NPSG have not improved care.
So, with this new survey process, JCAHO is raising the bar for healthcare quality - it has at least helped us to raise the bar. As JCAHO evolves, so do the thousands of healthcare organizations that it accredits, so here is to JCAHO and its new vision. Cheers!